1. Persistent pain: physiotherapy student experiences of person-centred care in musculoskeletal outpatient departments ANEURIN CLAYDON

2. Background NICE (2012) Quality Standards provide the foundation for an ‘NHS cultural shift' towards a truly patient-centred service Person-centred approach is advocated in the management of persistent pain (Physiotherapy Pain Association 2014) Physiotherapists’ have struggled to implement person-centred care into their practice in persistent pain management (Sanders et al. 2013) Image from: http://www.paintoolkit.org/assets/img/images/image-patient-doctor-happy.gif [accessed: 11.4.2016]http://www.paintoolkit.org/assets/img/images/image-patient-doctor-happy.gif

3. Aim To explore physiotherapy students’ experiences of person-centred care with patients’ experiencing persistent pain in a musculoskeletal outpatient placement setting Image from: https://medicine.tcd.ie/physiotherapy/assets/img/image3.jpghttps://medicine.tcd.ie/physiotherapy/assets/img/image3.jpg [accessed: 11.4.2016]

4. Design/ Method Qualitative interpretivist methodology Purposeful sample of final year physiotherapy students’ Topic guide developed following literature review Two focus groups conducted (including a pilot) Audio-recorded via Dictaphone In accordance with Cardiff University School of Healthcare Sciences Research Ethics Committee Image from: http://pgmonth.blogs.lincoln.ac.uk/files/2015/11/focus-group.jpghttp://pgmonth.blogs.lincoln.ac.uk/files/2015/11/focus-group.jpg [accessed: 11.4.2016]

5. Analysis Data from pilot study included Used Braun and Clarke’s (2006) process of thematic analysis Assistant moderator provided triangulation Opportunity for participant validation Familiarisation & coding Seeking, reviewing and defining themes Representing Account or Narrative Report Data Collection/Data Gathering Data Managing

6. Results and discussion Learning Influences Understanding Collaborative Holistic Tailored Self-management Demographics Pilot: 2 males, 1 female (all aged 21) Focus group 2: 3 males, 3 females (aged 20-21) Themes Theme 1: Understanding

7. Learning University vs placement Person-centred care Persistent pain ‘you’ve almost been taught to treat the problem rather than the patient in placement setting’ (Wayne). ‘It is drilled into us at university that it's really important to be patient- centred in our approach’ (Emily). ‘I was taught more to do on placement to treat what we see… at uni they tell you to do everything’ (Lois). ‘We are definitely aware of person-centred care but I wouldn't say necessarily in the context of pain management’ (Max). ‘Yeah it's hard to apply it sometimes’ (Geoff). Biopsychosocial v biomedical Theory-practice gap Inadequate pain education it’s all very well learning the theory … but when you actually see someone with it, it changes everything’ (Tyrone). ‘…too much of a minefield’ (Lois).

8. Influences Patient Experience Time Clinical Educator Guidelines ‘we're thinking about being patient-centred … but we've all got that I kind of want to get seventy per cent mentality’ (Tyrone). ‘we’re being clin-ed centred’ (Emily). ‘… my clin ed’s always been like give them a few exercises there's nothing you can do for their chronic pain and tell them to go back to their GP’ (Max). if you had a longer treatment session you could talk to them about everything else that is impacting other stuff’ (Max). Being assessed Placement duration Grade motivation Clin-ed centred Learning curve ‘I think the more experience you have… when you're first on outpatients you're just so scared about ticking all the boxes’ (Jess). I think four weeks for us as a student is a bit short’ (Geoff).

9. Conclusion The theory of person-centred care was theoretically well taught at university However students’ struggled to integrate knowledge of person-centred care into their clinical practice on a MSK outpatients placement This impacted the students’ learning and experience of managing persistent pain Image from: http://www.onlineuniversities.com/wp-content/uploads/2012/07/10twitterlecture2.jpghttp://www.onlineuniversities.com/wp-content/uploads/2012/07/10twitterlecture2.jpg [accessed: 11.4.2016] Implications Review university curriculum to facilitate the application of person-centred care into practice This could include a review into the teaching of clinical educators, duration of placement, placement assessment Universities should ensure the teaching of persistent pain is well- rounded and person-centred

10. References Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology. 3: 77-101. Briggs, EV. et al. 2011. Survey of undergraduate pain curricula in healthcare professionals in the United Kingdom. European Journal of Pain. 15: 789-795. Cruz, EB. et al. 2014. A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students. Physiotherapy Theory and Practice. 30(4): 254–260. Delaney, C. and Bragge, P. 2009. A study of physiotherapy students’ and clinical educators’ perceptions of learning and teaching [Online]. Available at: http://www.tandfonline.com/doi/pdf/10.1080/01421590902832970 [accessed: 13.4.2016]. http://www.tandfonline.com/doi/pdf/10.1080/01421590902832970 Etherton, J. and Waterfield, J. 2015. Preparing to manage patients in pain. The student perspective: a pilot. Journal of the Physiotherapy Pain Association. 38: 27-33. Hunt, A et al. 1998. Physiotherapists' perceptions of the gap between education and practice [Online]. Available at: file:///C:/Users/Admin/Downloads/09593989809057157.pdffile:///C:/Users/Admin/Downloads/09593989809057157.pdf International Association of the Study of Pain. 2015. IASP curriculum outline on pain for physical therapy [Online]. Available at: http://www.iasp- pain.org/Education/CurriculumDetail.aspx?ItemNumber=2055 [accessed: 13.4.2016].http://www.iasp- pain.org/Education/CurriculumDetail.aspx?ItemNumber=2055 Jones, L. 2009. Implications of IASP core curriculum for pre-registration physiotherapy education [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590038/ [accessed: 13.4.2016].http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590038/ Lindquist, I. 2006. Physiotherapy students’ professional identity on the edge of working life. Medical Teacher. 28(3): 270-276. Mudge, S. et al. 2014. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disability and Rehabilitation. 36(6): 457-463. NICE. 2012. Patient experience in adult NHS services [Online]. Available at: https://www.nice.org.uk/guidance/qs15 [accessed: 12.4.2016].https://www.nice.org.uk/guidance/qs15 Physiotherapy Pain Association. 2014. Physiotherapy framework – entry level graduate to expert: describing the values, behaviours, knowledge and skills of physiotherapists working with people in pain [Online]. Available at: http://ppa.csp.org.uk/documents/ppa-physiotherapy-framework-entry-level-graduate-expert-describing-values-behaviours [accessed 12.4.2016].http://ppa.csp.org.uk/documents/ppa-physiotherapy-framework-entry-level-graduate-expert-describing-values-behaviours Roskell, C. et al. 2012. Developing patient-centred care in health professionals: reflections on introducing service-learning into the curriculum. International Journal of Therapy and Rehabilitation. 19(8): 448-457. Sanders, T. et al. 2013. Biopsychosocial care and the physiotherapy encounter: physiotherapists’ accounts of back pain consultations. BMC Musculoskeletal Disorders. 14(65).

11. Questions?